Provider Demographics
NPI:1114661287
Name:LICHT, ARON
Entity Type:Individual
Prefix:
First Name:ARON
Middle Name:
Last Name:LICHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 TRANSIT ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1073
Mailing Address - Country:US
Mailing Address - Phone:914-525-1105
Mailing Address - Fax:
Practice Address - Street 1:84 TRANSIT ST APT 3R
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1073
Practice Address - Country:US
Practice Address - Phone:914-525-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program